BUFFALO, N.Y. – You may have diabetes and not even know
it. According the Centers for Disease Control and Prevention, 25.8
million people have diabetes. Of these, 7 million have undiagnosed
disease.

Getting treatment for diabetes early is crucial to avoid
complications such as kidney failure, blindness and increased risk
of heart disease and stroke. In order to target the undiagnosed,
health care providers are working to make diabetes testing
available in a variety of health care settings.

With this in mind, University at Buffalo researchers have
published results on one of the first studies that focused
specifically on the diabetic HbA1c blood test and whether or
not it was feasible to perform it chair side in dental office
practices.

The results recently appeared in the Journal of the American
Dental Association.

According to the study’s first author Robert J. Genco,
DDS, PhD, SUNY Distinguished Professor of Oral Biology and
Microbiology and Immunology, while dentists have been conducting
patient blood sugar tests for some time, very little in the way of
field trial research is available regarding dental visits and HbA1c
testing.

Hemoglobin is a protein in red blood cells that carries oxygen.
Glycated hemoglobin, or HbA1c, is a form of hemoglobin that
reflects plasma glucose concentrations.

The HbA1c blood test is considered essential for patients with
diabetes and pre-diabetes because its results can reflect an
individual’s blood sugar control anywhere from four weeks to
three months — not just that day. It also doesn’t
require fasting and can be done with a finger stick.

Genco said the goal of the study was to determine how practical
it was to perform the HbA1c test for diabetes as part of a
regular dental visit, recognizing that about two thirds of
individuals in the U.S. visit a dentist at least yearly.

“Research has shown that uncontrolled diabetes is
associated with an increased progression of periodontal
disease,” said Genco. “And those with diabetes
and periodontal disease may have worse glycemic control and
may be at greater risk for heart and kidney
complications.”

Genco noted the treatment of periodontal disease in patients
with uncontrolled diabetes may actually improve glucose control in
some patients.

The patients in the study were 45 years and older and were not
aware of their diabetic status. Genco and his team evaluated the
patients for diabetes risk using the American Diabetes Association
Diabetes (ADA) Risk Test and the HbA measurement.

Values for a normal HbA1c are less than 5.7 percent;
pre-diabetic levels are 5.7 percent to 6.4 percent; diabetic levels
are higher than 6.5 percent.

Of the 1,022 patients screened, 416 (40.7 percent) had
an HbA1c blood level of 5.7 or greater and were referred to
physicians for diagnosis and follow-up. Of those 416, 35.1 percent
received a diagnosis of diabetes within one year.

The patients were further studied according to where they
received treatment and testing: 78.8 percent were seen in a
community health center and 21.4 percent were seen in private
dental offices.

Of the patients who were given the ADA Diabetes Risk Test, more
than half seen in the community health center were at high risk of
developing diabetes. In contrast, in private dental offices, fewer
than one fourth of the patients were at high risk.

Genco said the study showed that it is practical to
check HbA1c of dental patients. However, there were some
issues that emerged during the study that needed further
evaluation.

First, only 21.5 percent of patients who were seen in the
private dental offices who had an HbA1c of 5.7 percent or
greater sought diagnostic workup from their physicians. This low
compliance occurred despite patients having consented to the
process of screening and possibly being referred to a physician
prior to taking part in the study.

Conversely, in the community health center, 78.8 percent of the
patients who were referred to physicians sought and obtained a
medical diagnosis.

Genco was surprised by these results and said there are a number
of possibilities that might cause poor compliance among study
subjects, among them denial, fear of being diagnosed diabetic,
costs, lack of motivation for patients who are not experiencing
symptoms and lack of access to medical care.

He added that the patients in the community health center were
primarily African-American and Hispanic. In those populations,
because of a higher incidence of diabetes, there may have been
greater awareness about the disease and its complications.

“Also, most of the dental patients in the community health
center were patients of record of a primary physician in that same
center with shared electronic medical and dental records,”
said Genco. “What this tells us is that in the future, we
need to consider within the study the reasons for poor compliance.
We should also take from this the success of the community health
center and the importance of a shared medical-dental
home.”

The study also found dental offices need standardized criteria
for documenting and diagnosing periodontal disease more
accurately.

Inspired by the fact that he never met either of his
grandfathers, both of whom died early due to complications related
to diabetes, Genco has devoted a good deal of his research to the
relationship between diabetes and periodontal disease.

“Because of this, I would like to make a contribution to
the understanding and control of diabetes, especially since it is
closely linked to periodontal disease.”

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